Associations Between State Alcohol Policy Environment and Infant and Maternal Outcomes: A Retrospective Cohort Study

Area of Science:

• Public Health
• Epidemiology
• Health Policy Research

Background:

• The Alcohol Policy Scale (APS) measures the U.S. alcohol policy environment and is linked to better health outcomes.
• Its utility in identifying policies that mitigate adverse effects of alcohol consumption during pregnancy is not established.

Purpose of the Study:

• To determine if the Alcohol Policy Scale (APS) can identify alcohol policy environments associated with reduced adverse infant and maternal outcomes related to prenatal alcohol exposure.

Main Methods:

• Combined APS data (total, consumption, driving subscales) with birth certificate and insurance claim data (2000-2019).
• Examined associations with birth outcomes, infant morbidities, and severe maternal morbidities (SMM) using regression analyses with state and year fixed effects.
• Conducted sensitivity analyses to confirm findings.

Main Results:

• The overall APS was associated with decreased birthweight as policies became stricter.
• The consumption subscale showed increased odds of SMM with stricter policies.
• The driving subscale was linked to decreased birthweight and infant injuries with stricter policies.
• All significant associations were invalidated by sensitivity analyses.

Conclusions:

• The Alcohol Policy Scale (APS) is not effective in identifying alcohol policy environments that may reduce adverse outcomes associated with drinking during pregnancy.
• Findings suggest current alcohol policy measures may not adequately address risks of prenatal alcohol exposure.